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O'Rourke C.1, Donovan A.1, Griffin E.1, Owens M.2, Klene M.3, Asiimwe E.3, O'Sulivan C.1,4
1University College Dublin, School of Public Health, Physiotherapy & Sports Science, Dublin, Ireland, 2Midlands Regional Hospital, Mullingar, Ireland, 3Nurture Africa, Nansana, Uganda, 4UCD Volunteers Overseas, Dublin, Ireland
Background: A disproportionate number of children with disabilities (CWDs) live in low-middle income countries (LMIC's). Physiotherapy led interventions have been shown to improve the management of children with disabilities in the Global North (Braswell Christy et al. 2012), and in particular in the management of children with cerebral palsy (CP). However, evidence is limited as to their effect in LMICs. The potential benefits of more holistic management strategies for CWDs involving therapy sessions alongside educational workshops for guardians, have yet to be investigated. This warrants further research as the burden disabilities places caregivers has been well documented (Hartley et al. 2005), and can have detrimental effects on both guardian and child health.
Purpose: The study objectives were two-fold: to assess whether a short, intensive physiotherapy intervention based on therapy and education could produce beneficial outcomes for children with physical disabilities, and to identify the effect of educational workshops on mothers.
Methods: An experimental single group design was piloted, using three pre and post-intervention measures reflecting the ICF-CY (the GMFM-66, the WeeFIM and a guardian attitudes questionnaire). Participants were children with physical disabilities known to the primary health centre, who were reviewed by senior physiotherapists and community health workers during initial home assessments. Inclusion criteria used were
(a) children under the age of eighteen,
(b) presenting with a form of physical disability as determined by the physiotherapists,
(c) whose guardian was available to attend the rehabilitation camp daily.
Those excluded were participants with acute infections, and those with orthopaedic conditions modifiable only through medical intervention. The intervention consisted of two 5-day rehabilitation camps, divided according to ability. Treatments involved individual therapy sessions and group-based activities, with daily educational workshops for guardians.
Results: Levels of disability varied over the 25 participants; the sample included 13/25 participants with impaired trunk control, 11/25 participants who were unable to sit independently, and 19/25 participants who were unable to stand independently. 21 children completed the intervention; 2 drop-outs were recorded, and 2 children were deemed unsuitable for the intervention due to medical complications. Analysis of GMFM-66 results indicated a statistically significant increase in total scores post-intervention (p 0.001) for the sample. WeeFIM results showed a significant change in the Mobility subset (p 0.001), with 71% of children exhibiting increased scores. Repeated guardian questionnaires (n = 20) showed changes in perceptions of disability and burden of care. All respondents felt the physiotherapy programme had benefitted their children.
Conclusion(s): Participants and guardians benefitted from an intervention aimed at improving physical function and education. Lack of health resources have, to date, limited the level of functioning of disabled children within the community. Implementation of a sustainable physiotherapy service at the primary health centre may improve the quality of life of CWDs within this community and reduce the mental and physical burden on their guardians.
Implications: Physiotherapy-led interventions for children with disabilities, including CP, can be particularly effective in low resource settings. These interventions have the potential to be an effective means of improving quality of life for CWDs and their families in LMICs.
Funding acknowledgements: The authors declare that no funding was received in respect of this research
Topic: Paediatrics
Ethics approval: UCD Human Research Ethics Committee Sciences (24/06/2015)
All authors, affiliations and abstracts have been published as submitted.
